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Medicine Non-adherence: Time for a Personalized Healthcare Approach?

It was interesting to note the article from Beth Snyder Bulik (1) that patient non-adherence to taking their prescribed medicines not only has a potential impact on their health and wellbeing, it also impacts the companies’ and healthcare providers’ bottom lines. She outlines that non-adherence can result in additional costs to healthcare systems of $300 billion annually and a loss of $637 billion in potential sales (2).

These are huge sums of money that certainly deserve attention, not only from Pharma but also regulators and healthcare payors/providers. How can we create better value for all parties, the researchers, pharma companies, healthcare providers, and end users, within the system? This is perhaps still a key question that all parties need to be focused on.

One of the challenges we all face is that this is a complex issue to solve. As a pharma – healthcare system, I think it is important we remember that we do not treat patients in isolation. The person taking the medicine usually will have a relationship (direct or indirect) with a variety of healthcare professionals, a healthcare system, and the pharmaceutical industry. There are therefore potentially many factors that could impact their taking the medication, including the impact of co-payments (3). In addition, the individual’s perception of themselves and their illness or condition seems to have a potentially complex interaction with their adherence to medication (4). The beliefs a patient may have on the cause of their disease and on its ability to be controlled appears to potentially impact whether they take their “meds”. If I don’t think this condition can be controlled, then why take the medicine? The patient’s emotional state may also have an impact. This has been extensively reviewed in diabetes (5).

The patient will have a variety of other social relationships and will experience varying degrees of community or isolation, important factors in our general wellbeing. People need different types and different levels of support to be able to manage their medications and life style choices. In a study investigating adherence to medicines in Type 2 diabetes, the baseline level of adherence was suggested to be a key factor in understanding how to support the patient (6). A variety of interventions by allied health professionals appear to have mixed effects in those patients with low adherence, with limited impact on improving adherence for those who were already taking their medicines adequately.

So, there does not appear to be a one size fits all approach. This was highlighted in 2012 by McKinsey and Company (7), who suggested that moving towards a person-focused approach was the way forward. They outlined some key elements of the plan, which need to engage the patient, integrate behavior change into the care model, and use networks and remote care technology to influence the patient. As noted, this will require a multi-stakeholder approach, which will require an appetite to change at many levels.

From an R&D perspective, my opinion is that we need to embrace a personalized healthcare approach. This is more than ensuring the right patient has the right medicine, at the right dose with the right biomarker/diagnostic for the right time. We need to focus on the right support for that individual patient or service user. This means embracing the psychosocial domain of engaging with the patient and providing the solutions they need.

Many of our clinical trials are focused on gaining hard quantitative measures of clinical efficacy. However, developing the focus on effectiveness in the real world and the individual experience of patients and healthcare workers, we may need to provide more weight to qualitative measures. This may seem an anathema to our science and technology mindset in R&D – however, we must remember that we do not treat individuals in isolation. Perhaps to develop this approach we need to develop new ways of investigating the narrative, or the story of the experience, to see the impact at a population level. There are plenty of opportunities to explore with a major economic motivation for all in the system.

Our aim ultimately is to create medicines of value and to maximize the benefits of scientific innovation. Perhaps it is now time we also embrace social science, health psychology, and behavioral economics to provide a humanistic, personalized approach to healthcare.

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